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Differentiation of Fatty Deposits and Cellulite

For the purpose of this discussion, the term ‘fatty deposits’ means areas of fat occurring in non-obese patients that are difficult of impossible to reduce with diet and exercise alone. Abdominal obesity caused by intestinal fat resulting in a ‘beer belly’ is not a fatty deposit and these patients are not candidates for PTCtx. An abdominal fatty deposit can be pinched, whereas intestinal fat causes taught skin over the abdominal muscles that are distended by the enlarged intestines and a pinch test allows for only skin to be pinched.

Those patients with Syndrome X’, or ‘Metabolic Syndrome’ should be aggressively treated for insulin insensitivity before of PTCtx is considered. It is important that patients be down to their ‘fighting weight’ before treatment is considered in order to achieve the best results in the fewest treatments.

Fatty deposits are differentiated from cellulite in that when they are pinched, no dimpling occurs. Fatty deposits can occur anywhere on the body or face. Terms that can be used to describe locations of fatty deposits on the body that may be treated with PTCtx are: ‘belly’, ‘bananas’ (under buttocks), ‘inner thighs’, ‘inner knees’, ‘love handles’, and ‘saddle bags’. On the face, ‘jowls’, ‘chin’, ‘cheeks’, and ‘suborbital fat pad’

Cellulite is characterized by a dimpled appearance brought about by alternating depressions and protrusions in the upper compartment systems of fat tissue. Cellulite is related to the presence of focally enlarged fibrosclerotic strands partitioning that subcutis. Cellulite may then be a hypertrophic response when connective tissue is overcome by progressive fat accumulation. Histologic aspects of cellulite are reminiscent of stretch marks and are identified within the hypodermal strands, thereby resulting in clinical skin dimpling. Cellulite occurs in stages and is classified as such:

  1. Stage 0 is the absence of cellulite. The skin on the thighs and buttocks has a smooth surface when the subject is standing or lying. When the skin is pinched , it folds, but does not pit or bulge. In this discussion, fatty deposits are considered stage 0 cellulite.
  2. Stage 1 is mild cellulite. The skin surface is smooth while a subject is standing or lying, but he pinch test is positive for the mattress phenomenon (pitting, bulging, and deformity of the affected skin surfaces).
  3. Stage 2 is moderate cellulite. The skin surface is smooth while a subject is lying, but when standing there is pitting, bulging, and deformity of the affected skin surfaces.
  4. Stage 3 is advanced cellulite. The mattress phenomenon is apparent when a subject is lying or standing.